So, off to the docs tomorrow to suggest I'm peri

[PrudenceDear]

This will be my 3rd or 4th attempt to try and be heard.

I'm seeing the doctor I saw last time, who did actually listen and suggest peri. He sent me for blood tests but they showed nothing. I tried to get a follow up appointment with him but it ended up with another dr who told me to come back after no periods for 2 years (I've already gone 11 months between for past 3 years - I'm 43)
So, if blood tests are suggested again, when should they be taken? I have no cycle. Last period was august 2015. The one before was march 2014. I do suffer with hot flushes but these stopped again a few months ago. They come for a few months, then disappear for a few months.

I've written out a timeline, symptoms and a few other niggles.

Why do you need a blood test to tell you. I knew. The blood test was negative when I.was 43. Last period at 49. I knew: Gaos, flooding ones, flushes. Dr gave me HRT at 48 because I said I needed it.

Am 55 now. Think last period was when I was 49. Think changes started at 41 looking back.

I think it's sad it's the last taboo. I hope you are OK? Welcome to the third, wiser, fulfilling age.

the blood test for this can often be a waste of time.

what do you want to happen?

Well I've had symptoms now for almost 7 years and I'm hearing, reading that I should be on hrt to protect against osteoporosis.

I don't need a blood test, I know that they're unreliable. They should be done on certain days of cycle and since my cycles are around 330 days long, I could have a long wait! This is what I was given last time, came back clear because I was at some point between cycles (that ended up being 17 months apart)
I guess I'm just looking for some fighting talk, some ammunition so I feel I can actually fight my corner.

On my last visit I was told to come back when I'd gone 2 years between periods.

get a gp who knows what they are talking about!

failing that have a good read at a few of the threads here, esp by a poster called pinkyperky (I think), she knows her stuff.

Can you ask to see a female doctor? The one I saw was very understanding and on HRT herself so she gave me loads of good advice.

Thanks.....
I've actually already seen 2 female doctors. The first asked lots of questions but it was several years ago and I'd not really worked out why I felt like I did.

Sadly, it was a female dr I saw last, who dismissed me, telling me to come back after no periods for 2 years. Apparently, it can be quite normal to miss numerous periods.

If you are worried about osteoporosis do you have any risk factors:

Thyroid disease
Steroids
V low weight
Mother, grandmother, sister with osteoporosis

Unless it's actually diagnosed you are unlikely to be offered treatment for it.

If you are really worried about it perhaps you should ask for a private dexa scan. Are there any reasons why it's a concern for you?

Maybe have a list of all your symptoms with you and say that you are struggling to cope with them. It worked for me. Good luck

prudence

You are right to be worried and other previous posters here are incorrect. Sorry PPs!

The facts are that at 43 you are having an early menopause- almost 10 years before the UK average of 52. if you have had no periods or very few for some years then that is a reason to use HRT as your bone health and heart health will be compromised.

The NICE guidelines (out Nov 15) stated that women under 43 ought to have a blood test- women over 45 do not because peri is normal from 45- 55.

Your GP ought to have read this and the way to test you.

The blood tests are on day 2-5 of a cycle or anytime if you do not have a cycle.

You do not need a family history of osteoporosis to be at risk. Your risk is low oestrogen for 10 years before the average age.

Have a read of this website www.daisynetwork.org.uk and insist at your GPs that they refer you to a gynaecologist who can run blood tests - FSH and LH - and others, to get a clear idea of what stage you are at.

Thank you Polly

I've been on other threads and had some really good advice, I think possibly from yourself. Just trying to get some strength up as some doctors seem so reluctant to consider perimenopause.

So blood tests can be anytime, but should they then be repeated after 4-6 weeks?

The doctor I'm due to see took me seriously last time & peri was his first thought but I couldn't get a follow up with him.

I have bad days but mostly I think I'm over the emotional, confused, mood swings, stress. The hot flushes have stopped for the past couple of months which may indicate a period at some point in the next few months.

I thought menopause was technically two years after last period.

With all due respect the only way to diagnose osteoporosis is via a dexa scan. I'm still interested to know why the op thinks she might have osteoporosis.

I do know about this because I have it. I took HRT from 48. I am also a recovered anorexic, have had thyroid disease and a mother and grandmother with it. Mine was diagnosed when I broke a bone after a low impact fall.

Osteoporosis is serious. If the OP has it she needs more than HRT. If she had other risk factors she needs a dexa scan, not a test for the peri menopause. HRT didn't stop mine in its tracks.

Sorry, posted too soon

So on a day to day basis I don't really suffer at the moment but I am concerned for my health in the future, so thank you for re-iterating that. I'm just trying to read up and go fully prepared for battle!!
I hate going to the doctors and usually avoid as much as I can...

I don't think the op is saying she has osteoporosis but that hurt can protect against it. So now us an appropriate time to discuss that with a dr.

Sorry BeaufortBelle, I thought I'd typed that is like to protect myself from (the risk of getting ) osteoporosis - I don't think I have it. I don't want it. I read that if you have an early menopause (considered to be before 45?) then you should take hrt to help guard against it. I realise that menopause is 2 years after last period but given that I regularly go 11-15 months between periods when up until 6 or 7 years ago they were very regular, it would seem that I'm heading towards an earlier than average menopause. I'm sorry if I've not worded a sentence well, or my wording/understanding isn't correct.

I was only looking for a bit of encouragement and hand holding.

My apologies, I thought you were saying you wanted HRT to prevent osteoporosis. I think, actually I know from personal experience HRT alone won't prevent it and the average GP is pretty lacking in knowledge about it.

As a post menopausal woman with osteoporosis, presently nursing a vertebral compression fracture, if it is something you are seriously concerned about you need to ask for a dexa scan. Do you have any risk factors other than an earlyish menopause to cause you to be concerned?

Beaufort- HRT for women with a premature or early menopause IS the recommended treatment. That's what the OP was asking and she's right! Being low in oestrogen from age 43 or thereabouts increases the risk of osteoporosis. This is why NICE recommends that all women with an early menopause use HRT.
HRT will and does prevent osteoporosis. I don't know your own experience of it but if it's used early enough and at the right dosage (its effect is dose dependent) then it works.

NICE

Managing premature ovarian insufficiency

1.6.6 Offer sex steroid replacement with a choice of HRT or a combined hormonal contraceptive to women with premature ovarian insufficiency, unless contraindicated (for example, in women with hormone-sensitive cancer).

1.6.7 Explain to women with premature ovarian insufficiency:

the importance of starting hormonal treatment either with HRT or a combined hormonal contraceptive and continuing treatment until at least the age of natural menopause (unless contraindicated)

that the baseline population risk of diseases such as breast cancer and cardiovascular disease increases with age and is very low in women aged under 40

that HRT may have a beneficial effect on blood pressure when compared with a combined oral contraceptive

that both HRT and combined oral contraceptives offer bone protection

that HRT is not a contraceptive.

1.6.8 Give women with premature ovarian insufficiency and contraindications to hormonal treatments advice, including on bone and cardiovascular health, and symptom management.

1.6.9 Consider referring women with premature ovarian insufficiency to healthcare professionals who have the relevant experience to help them manage all aspects of physical and psychosocial health related to their condition.

Beaufort the reason HRT didn't help you I assume is because it was too late. If you had an eating disorder then your bones would have deteriorated very early one- an eating disorder and thyroid problems are key risk factors. So using your own experience does not mean that HRT form premature menopause is the wrong treatment.

(I had osteopenia myself at 48 but now have normal bones thanks to lifestyle, diet, HRT [though HRT was not prescribed for my bones] and a fantastic consultant who monitors it all for me.)

A DEXA scan will show how bones are doing. Prudence is concerned quite rightly about prevention which is key to avoiding problems in 10 or 20 years' time.

Menopause is defined as 12 months after a period.

Then why doesn t the op take the nice guidance to the dr and say what she wants and if she doesn't get it ask for a gynae referral. Will cost her about £250 and if what you say is true then it's money well spent. Could I have taken HRT earlier, probably. Nobody told me to but it was prescribed as soon as I said I was finding menopause difficult and although I had a blood test at about 43 it was negative but I wouldn't have contemplated HRT at that point. I found out about the osteoporosis by chance and take the appropriate drugs for it. The op would be much better ensuring she has dexa scans than taking drugs she may not need.

I think Prudence will have to answer that for herself Beaufort!
Taking the NICE guidelines is a good idea, but perhaps when she first posted she was not aware of them or how to find them?

It won't necessarily cost £250. First appts are more expensive then follow ups, but £250 is far more than I pay for regular appts in Harley St.

The blood test you had at 43 may have not shown anything if it was done at the wrong time ( days 2-5 and them after mid cycle, and then repeated a month later) . Also, your condition may have been a result of anorexia and thyroid issues which presumably meant you missed periods for many, many years and had low body weight too?

I'm not sure why you say you'd not have taken HRT at 43. If someone has premature or early menopause then that is the treatment advised by drs.

I don't think you have understood the issue here. HRT for women with a premature or early menopause is prevention. A DEXA scan will show how her bones are now, today, but being without estrogen 10 years early means she is likely to lose bone very quickly, then trying to remedy that with other drugs like bisphosphonates is a bit like filling the bath with the plug out! And those drugs can have huge side effects if used long term.

Don't you 'get' that prevention is the issue ?

Prudence just seen your post on the other thread- great that it looks as if you are making progress.

HRT doesn't 'stop osteoporosis' in its tracks (Beaufort) but the research papers show that most women find their bone density increases by around 2-3% per year using HRT. So, depending on how low the bone density is to start with, this may prevent osteoporosis in some women with osteopenia, or may help women with osteoporosis who can't take other drugs. It depends on your T score.

This is link is from 'Climeratic' the International Menopause Society's journal and written by Prof Studd, a UK expert on menopause.

www.ncbi.nlm.nih.gov/pubmed/19437196

The main points are these:

"A case is made for estrogens to be the first-choice therapy for the prevention and treatment of osteoporosis in women below the age of 60 years.
Estrogens produce a dose-related increase in bone density and also, by their effect on collagen, have a beneficial effect not only on the bone matrix but the intravertebral disc.
Bisphosphonates do not have that effect upon the disc.

Estrogens are also associated with other beneficial effects upon mood, vasomotor symptoms, pelvic atrophy, sexuality and quality of life.

The data from the Women's Health Initiative (WHI) study are used as a justification for not using estrogens but the neglect of estrogen therapy by physicians antedated this and other studies by many years. Subsequent publications from the WHI study show that hormone replacement therapy, particularly estrogens alone, is not associated with the excess side-effects found in the older population.

The substantial but non-significant decrease in heart attacks, breast cancer and mortality in women under the age of 60 taking estrogens alone should persuade the advisory bodies to revise their judgment on the benefits and safety of hormone replacement therapy in this population."

Thank you.

It was your words, along with a couple of others, who made me re approach the doctors.

You've made quite a lot of assumptions there polly. I never had an absence of periods fir years. Nor did my bodyweight drop below 7st 7lb. I had a peri test at 43 and it was negative. My GP knew about the thyroid, anorexia and history. I was never willingly given HRT. I resent the way you have addressed me as though I am negligent and stupid to be honest. I'm also not sure I'd take unnecessary drugs. Still my osteoporosis is all my fault and I'll suck up the consequences, including the side effects of the bisphosphonates which silly me could have been prevented if I'd started HRT in the breast cancer storm in 2003. Oh silly, silly me

Beaufort I'm sorry if my style of posting upset you. I'm posting while working (for myself!) so my posts tend to be frank and to the point but I don't intend them to be unkind.

I think it's helpful to make certain points about HRT and bone density and treatment not aimed at you especially, but for other women reading, especially as my own personal experience contradicts yours.

You did appear to miss the point about HRT being used to prevent osteoporosis - you said so a couple of times-and called it 'an unnecessary drug' despite the fact that it's now accepted mainstream medical treatment.

And you did appear to dismiss Prudence's worries and tell her that a DEXA scan was all she needs- when clearly it's not.